Anxiety Keeps Some Smokers from Quitting

Breaking news! Nervous people smoke more than other people. More breaking news: they also find it harder to quit. Those may not be the kinds of insights that get the attention of the Nobel committee, but a new study in the journal Addiction shows how even so straightforward an idea may yield lifesaving benefits.

The chemistry of nicotine packs a powerful addictive wallop; if it didn’t, tobacco would wouldn’t be such a hard substance to quit. Still, plenty of people do quit; what’s always puzzled epidemiologists is why a hardcore group can’t. In the U.S., which leads the world in driving smoking rates down, 20% of the population still lights up. That may be less than half of what it was back in the ashtray-in-every-room Mad Men era, but it also means that more than 50 million Americans continue to smoke, even if they have to huddle outside office buildings or in parking lots to do it. Psychologist Megan Piper of the University of Wisconsin-Madison Center for Tobacco Research and Intervention (UW-CTRI) wanted to determine what keeps these dead-enders hooked. (More on Time.com: Photos: Your Doctor Wants You to Smoke)

Piper and her colleagues studied a sample group of people who had enrolled in a free UW-CTRI smoking cessation program. Of the 1,504 subjects, about one-third met the criteria for an anxiety diagnosis currently or in the past — nearly twice the incidence of anxiety in the population as a whole. Panic attacks were the most common form of anxiety, affecting 455 of the participants, followed by social anxiety (199 people) and generalized anxiety disorder (99). Some of the subjects had more than one condition.

Piper believes that underlying anxiety conditions may explain why nicotine lozenges and patches, which can be extremely effective in helping many smokers quit, seem to have far less effect on others. If it’s anxiety that drove those people to smoke in the first place, nicotine supplements will satisfy only one part of their addiction — the chemical part. They’ll do nothing for the emotional component. (More on Time.com:AHA: Don’t Be Fooled, Smokeless Tobacco Isn’t Exactly Safe)

So temperamentally dependent are anxious smokers that many, according to Piper, start to suffer withdrawal symptoms even before they actually quit — as if the dread of facing the world without a smoke is enough to trigger the cold-turkey experience. Bupropion (an antidepressant marketed as Zyban) also does not seem to do much to help anxious smokers quit, though it is not entirely clear why.

None of this means that anxious smokers who want to stop are without recourse. Piper believes that all doctors treating smokers should assess them for anxiety too. If a condition is diagnosed, proper therapy can be doubly beneficial — helping patients ease their angst and kick the butts.